Addiction

Sees addiction as an illness 

• A problem within the person - either an addict or not 
  
• Irreversible - emphasis on treatment not cure

Initiation - Smoking: 

• There is an underlying physiological abnormality (predisposition, more likely/vulnerable)
• Forshaw: Smoking is caused by combination of pressues - one being biological (supporting that it is biologically predisposed)
• Lerman Et Al - found that those with the SLC6A3-9 gene (regulates dopamine) are less likely to smoke - absense of this gene makes people predisposed to smoking 
• Predisposition is inherited - Kendler found a heritability rate of 60-70% 

Maintenance: Smoking 

• Smokers maintain smoking to avoid withdrawal symptoms caused by the lack of nicotine. (Nicotine timulates the release of dopamine in brain which increases levels of dopamine providing feelings of pleasure and relaxation) - Shachter "Nicotine Regulation Model" smokers continue to avoid withdrawal symptoms. Gave smokers high and low levels cigarettes found those with low had to smoke 25% more to maintain levels due to increased withdrawal
• Could be genes that maintaining - Sabol Et Al:  Those without the SLC6A3-9 gene more likely to remain a smoker (because of gene needs more dopamine to feel pleasure) Support: Corigall and Coen: injections of drugs which block dopamine reduce smoking in rats (reward is gone)

Relapse: Smoking 

• Relapse occurs as a response due to tolerance and withdrawal (Shachter - Nicotine Regulation Model) Quitting smoking it very difficult as body is used to nicotine and relies on it for dopamine release. Quitting deprives body and means low levels of dopamine until body readjusts. This causes upleasnt withdrawal - relapse occurs to avoid 
• Lerman Et Al - MRI Scan (1) tested smokers after 1 cigarette and (2) after 1 night where they refrained from smoking.(2) caused increased blood flow to area responsible for attention, memory and reward - stopping smoking changes brain chemistry and makes more susceptible to begin again 

Initiation: Gambling

• Gambling is causes a rush of adrenaline/dopamine, as the act is an accute stressor. The stress of awaiting the outcome triggers release of adrenaline which induces a rush and natural high. This burst of energy becomes highly addictive as it is rewarding 
• Due to specific gene - Comings Et Al found pathological gamblers carried D2A1 gene (which regulates dopamine)
• Brain activity could also make someone more likely to gamble - Rugle and Melamend found that EEG recordings of problem gamblers were same as children with ADHD (trouble with controlling attention and behaviour) - due to this biological weakness person is predisposed

Maintenance: Gambling

• Gamblers maintain to avoid withdrawal and trigger the high again - Wray and Dickerson found gamblers who are not allowed to gamble report withdrawal symptoms (not as intense as chemical) - Orford Et Al Alcoholics and gamblers report same intensity of addiction but gamblers suffer less severe withdrawal 
• Brain Abnormalities - Potenza Et Al looked at pathological gamblers and found increased blood flow in brains compared to non-gamblers when they viewed gambling videos 

Relapse: Gambling

• Relapse occurs to tolderance and withdrawal. Ciarrochi et al found when gamblers give up they replace the addiction with another (BIG DIFFERENCE TO SMOKING WHICH IS CHEMICAL)

AO2 of Gambling:

• Unlikely a single gene could cause smoking/gambling - likely multiple genes are involved
• However, it does explain individual differences in gambling - explains why some people with the same life pressures become addicted to gambling whilst others don't
• Although they can explain individual differences, it fails to explain situational or environmental factors which coudl be more likely to explain e.g. someone could have a predisposition to drink however never drink, it is what triggers them in the first place that gets them to start which could probably be environmental 

Smoking AO2:

• Neglects other determining factors - e.g. what lead them to smoking in the first place, reductionist?
• Unlikely a single gene could cause smoking - more lkely that multiple genes are invovled
• However, biological research is useful for real life application e.g. medication, could screen people for predisposition 
• Places all the blame in the persons genes, they aren't responsible
• Deterministic 

Addiction is caused by false beliefs:

• Beliefs are autmoatic and therefore hard to stop, by correcting these beliefs we can exercise their free will and remove addictive behaviour. Moving behaviour from determined to free will

Initiation: Smoking 

• Expectancy - start smoking as have positive beliefs about benefits (short term benefits, not long term consequences). Expetancy that smoking reduces stress and negative feelings or makes look attractive, start social interactions, control apetite or weight gain 
• Coping/Self Medication - People start as have hard time concentrating. Heishmann found cigarettes enhance performance of well learned behaviours. Brandon and Baker also found people start smoking due to boredom, once period of boredom over, left with addiction. 
• Self Efficacy - Knows behaviour is addctive but they believe they are able to control the behaviour (have high self efficacy) and all the problems that come with it 

Maintenance: Smoking 

• Cognitions change from positive beliefs to reliance 
• Self Medication Model - Beck Et Al "Vicious Circle of Addiction": smoker is unhappy for this they engage in smoking. This leads to physical, social and financial problems. This makes the user feel worse and they smoke more to alleviate mood 
• Coping - Ciggarettes produce improved cognition, increased concentration, alleviate boredom
• Self-Efficacy - Indiviudals are unable to cope with the withdrawal process and therefore don't give up. They don't have the self-efficacy to stop
• Expectacy - They expect withdrawal to be extremely difficult so don't give up

Relapse: Smoking 

• Coping - The negative feelings of withdrawal are immediately alleviated by smoking - symptoms make make user feel unwell or self-concious, a return to smoking is the easiest way to remove these feelings 
• Self-efficacy - The relapsed smoker may feel that they have given up once they will be able to do it at any time they want. They believe their return isn't permanent 

Smoking AO2:

• Cognitive approches are useful in describing the thinking processes of people who have become addicted to smoking/gambling. They have provided the basis for some helpful therapies - studies have shown that nicotine patches alongside CBT in combination changes the positive expectancies of smoking and leads to stopping 
• Doesn't offer very convincing explanations - much is focused on problematic behaviour not the actual loss of control addicts feel and why they feel this way 
• Juliano and Brandon found that smokers did believe that cigarettes would stop moods, cravings and weight gain
• Takes into account individual differences - why some people become addicted and why others don't due to faulty thinking patterns. 

Initiation: Gambling

• Expectancy - They start because they have positive beliefs about the benefits of gambling (short term benefits not long term costs) Sharpe and Tarrier - although gambling is initiated by operant conditioning (reward) the excitement generated by gambling and occasional wins encourages further gambling by focusing on expectancies
• Gambling starts as the behaviour beings positive feelings - which create positive thoughts
• Coping/Self Medication - People start gambling as they are bored, provides means

Maintenance: Gambling

• Cognitiions change from positive beliefs to reliance 
• Self Medication Model - Beck Et Al's "Vicious Circle of Addiction": gambling provides user of way of improving their mood, causes financial difficlies which in turn cause negative feelings which the gambler escapes through gambling 
• Coping - The experience of excitement, the possiblity of an occasional win makes the user feel good and encourages them to view it positively 
• Expectancy - the percieved benefits of famblign are huge - gamblers see it as possibly life changing - occasional wins support these expentancies 

Relapse: Gambling 

• As the symptoms are pericved to be painless - the user believes they can stop at any time - believe it isn't serious 
• Gambling relieves boredom - gamblers relapse as life seems empty without it

AO2:

• Li found that gamblers who gambled to escape reality often had other substance dependancies - have positive beliefs about these things 
• The self-medication model argues some kind of psychological distress is necessary for PG to be initiated and there is some evidence that depression is prevalent in pathological gamblers, however unsure if this is cause or effect 
• Can be useful for some therapies 

Addiction is learnt. Sees addictive behaviours as:

• Acquired habits which are learned according to the principles of social learning 
• Things can be unlearned - no different from other behaviours

Initiation: Smoking

• SLT - It is most likely someone starts smoking due ot the observation of role models and imitate what they see. Whether it is initiated depends on the percieved consequence. Akers and Lee foudn using self-report methods a positive correlation between social learning variables (whether friends smoked, how often friends smoked, parents smoking)and smoking. 
• Operant Conditioning - Smoking doesn't cause immediate physiological pleasure, however it allows the individual to make friends with a group fo smokers - which causes positive reinforcement 

Maintenance: Smoking

• Maintenance occurs through classical and operant conditioning. Like the biological model, smoking causes a positive reinforcer - a physiological buzz. The smoking is maintained as this buzz is associated with smoking. In addition, abstinence causes withdrawal, the smoker maintains the habit due to negative reinforcement - want to escape symptoms 
• Smoking becomes a ritualised habit - they are learnt associations that are hard to unlearn. This can also occur in social groups. The act of smokin forms an important part of the day for the user e.g. meal times

Relapse: Smoking 

• Relapse occurs due to association and punishment. Strong associations between cues lead to withdrawal symptoms which are unpleasant (punishment). The smoke to escape the punishment. Cue-reactivity theory explain that the users only need to touch the paraphanalia associated with smoking to experience a strong craving 
• Smoking is prevalent in society - if we see others smoking we will want to 

AO2:

• Explanations based on classical and operant conditioning can probably account for some aspects of addictive behaviour, however don't take into account that humans are thinking beinfs and do not respond to simple stimulus-response behaviour
• What about individuals who don't know anyone who smokes
• Young people are 8 times more likely to smoke if their peers do, also parental smoking increases liklihood 
• Acknoledges the importance of social and environmental influences as a prediction of smoking 

Initiation: Gambling 

• SLT - It is most likely that a person starts gmabling due to observation of role models and they are imitating the behaviour they are witnessing 
• Operant Conditioning - Winning money causes pleasure and the behaviour is positively reinforced

Maintenance: Gambling 

• The behaviour is continued as the rewards are relatively easy to come by - placing a bet provides encouragement and reward to continue gambling (positive reinforcement), this constant association of excitement with gambling reinforces the relationship 
• Gambling provides a partial reinforcement - a schedule of reinforcement that produces persistant learned behaviours - predictable activies become boring, Fruit Machines not boring as will always cash out eventually
• In order for gambling to stop, it must be consistently associated with negatvie side effects 

Relapse: Gambling 

• Relapse occurs due to associations and punishment 
• Strong associations between cues lead to withdrawal sumtpoms which are unpleasant (punishment), they gamble to escape this punishment. Cue-reactivity paradigm, the materaials associated with gambling create craving which leads to gambling 
• Gamblers who give up are surrounded by reminders of the behaviour which creates excitement and anticipation

AO2:

• Explanations based on classical and operant conditioning may account for some aspects of addictive behaviour however sees humans as stimulus-respose robots that just respond to evinronmental triggers
• The central idea of SLT stresses importance of role models and therefore has real life application as it explains the importance of the media is influencing people
• Cant explain all types of gambling - short or long/ some people recieve rewards and don't get addicted 

• The TBP has been successfully applied in prediction of a wide range of social behaviours including stopping drugs and smoking. Research has shown that intentions can be predicted using the three elements. Armitage and Conner found that percieved behavioural control improved the cariance in intention by 6% compared to the assessment of attitude and subjective norm alone. Suggests behaviour is impacted mostly by behavioural control 
• Many studies have found a similar outcome, showing that the TPB is successful in predicting intention, however it only predicts intention not actual behavioural change. Therefore TPB is primarily an account of intention formation rather than specifying the processes involved in translating the intention into action
• Methodological Issues - Attitudes and intentions are assessed using questionnaires; these can be poor representations of the attitudes and intentions that eventually exist in the behavioural situation and therefore poor predcitors of actual behaviour. 
• On top of this, it can be criticised for being too rational and failing to take into account emotions and compulsions of human behaviour. When filling out a questionnaire about attitudes and intention people may find it difficult to anticipate the strong emotions that stop them from doing what they want e.g. quitting smoking 

• The research on TPB is almost entirely correlational, it only demonstrates that there is a link between positive and negative outcomes and certain behaviours, no cause and effect 
• The TPB can be used as a framework for understanding the processes that lead to addiction but can also be used as a means to understand prevention and treatment. Therefore can be used to develop programmes/interventions to being about long-lasting changes in behaviour
• Changing behavioural attitude - Support comes from the campaign by the ONDCP which launched a successful anti-drug campaign that tried to influnence teens attitude rather than list risks (teens are not risk-avoidant). Tried to create a different attitdue: told them drugs were inconsistent with independence and achieving aspirations - supports that behavioural attitude effects intention
• Changing subjective norms - Anti-drug campaigns give data about percentage of people engaging in risky behaviour to change subjective norms (they may think more people smoke than actually do if all there friends do) - exposure to thse stats that say people don't smoke correct subjective norms 
• Godwin provides support as during their study foudnt hat all three elements of TPD helped to explain intentions, percieved behavioural control was most important predictor (as predicted by the model) - therefore prevention programmes shoudl help smokers to focus on the will-power required to give up smoking

According to the learning theory, we can unlearn innapropriate behaviours such as additionn by using various learning-based techniques. 

Aversion Therapy:

• Based on the idea of punishment rather than reward and has been used to treat alcohol and smoking addiction. 
• Early programmed adiministered mild electric shocks every time person took sip of alcohol or puff of cigarette - these were not successful as the effects didn't last outside clinic 
• To avoid this, alcoholics been given drug which makes them very sick every time they consume alcohool and so establishes link between alcohol and vomiting = shown to be effective, however, it requires person with problem to take drug in first place (may not be willing to comply) and it ignores the reasons that led to the addiction in the first place
• Rapid smoking technique had some success - individual has to sit in closed room and take puff of cigarette very 6 sconds, the rapid inhalation leads to feelings of nausea and illness - therefore association unpleasant feeligs with smoking and deveop aversion to cigarettes
  There is some evidence that this can be helpful, however results have not been consistent and could develop risks for the person - also doensn't tackle underlying problem 

Cognitive Behavioural Therapy (CBT): 

• Technique assumes addiction is a means of coping with situations (depression/peer pressure)
• Treatment aims to help addicts recognise high-risk situations and either avoid or cope with them wihtout using addictive behaviour 
• CBT often invovles CBT often involes training in social skills and stratergies for preventing relapse as well as traiditonal cognitive tech's scuh as challenging faulty thinking pattenrs 
  • As relapse is frequently associated with matiral problems CBT also involves their partner 
• Gamblers are encourages to correct cognitive errors, such as the belief that they can control and predict outcomes and are encourgaed to learn new behavioural strategies 

AO2:

• In support for the use of gambling and CBT - Sylvainevaluasted the effectiveness of CBT in sample of male pathological camblers. Treatment of CBT and social skills training and relapse prevention training - found significant improvements after treatment, maintained after one year
• Found to be a reasonably effective therapy, but more effective when used in combination with medication e.g. Feeney found those who recieved just CBT reported 14% abstinence rates but CBT with medication went to 38%

Motivaional Interviewing (MI) - element of CBT:

• Relatively new, focuses on trying to help people with addiction to develop the motivation to change their habits.
• They are asked to review their addctive habits and weigh up the positive and negative effects 
• Miller and Rollnick suggested MI is about motivational aspects of changing people behavoiur - it involves avoiding labelling, asking evocative questions, listening disadvantages and allows the person to come to a decision about their behaviour themselves 

AO2: 

• As of yet no research into long-term effects. However, Dunn found it was effective in helping clients with addictions, particularly as a way of encouraging them to progres to more intensibe treatments 
• Burke Et Al found MI has led to 56% reduction in alcohol consuption in the people offered the treatment 
• However, cant work for everyone as it depends on the individuals personality and how motivated they are 

• Overall the research suggests that psychological interventions are an effective way of stopping addictions 
• When comparing all three different types there was no siginificant overall diffferences in their effectiveness either at a one-year follow up or a three-year follow up. However it was certain that different treatments were more suited to different individuals (e.g. People with low levels of dependence responded most favourably to CBT) - therefore important for the person recieveing the therapy to choose which will be most effective depending on their personality ect
• CBT requires time and patience from the client which might not suit everyone. Some people might not have the necessary motivation to complete treatment 
• However, although they might not be useful for everyone they do offer a long term solution 

Biological Therapies based on the idea of addiction as a disease and usually involve the use of medication. They aim for complete abstinense (if this happens will usually experience withdrawal symptoms) therefore any treatment will also try to manage these symptoms. 

Bio interventions have been widely used to help people give up smoking. These drugs are useful and have all been shown to be effective in controlled clinical trials in comparison to placebo. 

Nicotine Replacement Therapy (NRT):

• Nicotine medications such as nicotine gum, patches and nasal sprays mimic or replace the effects of nicotine derived from tobacco, these help to stop smoking in many ways:
  • Provide negative reinforcement - even in low doses help to relieve withdrawal symptoms 
  • Provide positive reinforcement - because of their arousal and stress relieving effects. Positive reinforcement is most likley in response to rapid-delivery treatments e.g. nasal spray and gum. These products allow smokers to self-administer nicotine when they have the urge to smoke cigarettes. Nicotine patches deliver nicotine gradually and result in sustrained nicotine levels throughout the day (not positive reinforcement)
  • They desensitise nicotine receptors in the brain. This means if the person lapses and smokes a cigarette whilst on nicotine replacement therapy, the cigarette will appear less satisfying 

Bupropion:

• The antidepressant drug Bupropion has also been used as a treatment 
• Works by increasing brain levels of dopamine and norepinephrine, stimulating the effects of nicotine on these neurotransmitters 
• As one effect seems to be to block the nicotine receptor it could reduce the positive reinforcement from a cigarette in case of a lapse
• Watts et al showed thhis to be a reasonably successful way of treating smoking 

Varenicline:

• Varenicline is a drug that casues dopamine release in the brain 
• It also block the effects of any nicotine added to the system 
• Clinical trials have found that varenicline is superior to bupropion in helping people to stop smoking 
• It has alos been shown to reduce relapse in smokers who had been abstinent 12 weeks after inital therapy 

• For most smokers nicotine medications are not percieved as being satisfying enough as smoking and some will just relapse (this is becasue the avaliable nicotine replacement therapies deliver nicotine into the bloodstream much more slowly than an actual cigarette)
• Meta-analysis of the effectiveness provide supports the view that it is nicotine rather than other components of cigarettes that maintains the addiction. 
• Although the treatment has been criticsed as still harmful, it is seen as outweighing certain risks. For example a pregnant woman is advised to stop smoking however if they feel they cannot then nicotine maintenance therapy is useful as the body will not go through withdrawal
• Biological approaches to treatment can be helpful in reducing addictive behaviour particularly in people who are very dependant - they are fast, effective and require little motication to change 
• However, critics argue it takes away the responsiblity from the individual and categorises addictive behaviour as a disease. 

Health promotion aims to enable people to gain control of and therefore enhance their health 

Harm Minimisation:

• Accepts that people will engage in risky behaviour but aims to reduce the health effects by encouraging the drug users to be safer
• E.g. Needle Exchange Points - so that individuals do not share equipment, reducing the risk of HIV or AIDS. 
• Safer drug use can be encouraged by messages that involve heirarchy of behavioural changes
  • Do not use drugs - If you must use drugs, do not inject - If you must inject do not share equipment - If you must share, sterlise the injecting equipment each time 
• This approach tries to educate drug users about safe practices - another way is offering them medically controlled drugs e.g. methadone instead of heroin 
• The Bleachman Campaign - major media and community outreach designed to influence San Fran's drug users to clean their needles with bleach. It wasn't to promote drug use but a short-term solution aimed at stopping the rapid speed of HIV in a high risk population. The campaign seemed to attack social norms of drug users father than emphasisng knowledge and fear - showed had a positive effect on drug users.
• However, these attract a lot of criticism as ti appears to condone drug use.

Peer Based Programmes:

• We prefer to take advice from people we like ourselves or people have repsect for 
• Therefore it could be suggested health-education programmes run by peers will be more successful than by adult strangers or teachers
• Bachman et al looked at health-promotion programme that asked students to talk about drugs to eachother, to state their dissaproval of drugs and say they didnt take drugs - idea was to create a social norm that was against taking drugs and give them practice at saying no - results showed programme resulted in an attitude change towards drugs and led to reduction of use of cannabis 
• However, Flay Et al - intervention programmes only effective in stopping experimental smokers. They do not tackle the problem of those destined to become adult smokers

Legalisation - Restricting/Banning Advertising 

• Adveritising aims to promote the idea that smoking and drinking are sophisticated, sex things to do - social learning theory woudl suggest that such advertising causes us to associate these characteristics with smoking and drinking
• In the UK cigarette advertising was banner in 2003 
• Alcohol advertising companies claim advertising simply encourages exsisting drinkers to change brands rather than promote consumption

cont.... 

• Between 1989 and 2000 there was a strong correlation between advertising expenditure and alcohol consupmtion between children ages 11-15
• Also an American study showed 15-26 year olds strong correlation between number of adverts they watched and the amount of alcohol they consumed
• Studies comparing cigarette consumption before and after total bans on advertising (e.g. Finland) suggest a significant redcution that cannot be attributed to other measures 

Increasing the Cost:

• Raise price of cigarettes and alcohol by increasing taxes - this encourages people to stop and deters chidren from starting in first place. In cognitive terms, powerful factor when weighing up percieved costs of their behaviour

Reducing the harmful components:

• A proposal in the USA suggested a gradual reduction in nicotine content of cigarettes over a period years - so they would be weaned off the addiction. 
• One concern is smokers could compesnate and smoke more e.g. Shachter Nicotine Regulation Model 

Ban on smoking in public:

• In 2007 UK introduced law that it is now against law to smoke in any encolsed public places 
• 2 objectives - firstly protected the general public from second hand smoke. 2 - aimed to reduce levels of smoking by reducing the likelihood of currently common cues (pubs, restaurants) becoming associated with smoking and people being influenced by others
• Support comes from the fact that nearly 250,000 people quit smoker quit smoking after ban 
• However, recent statistical analyses (West) show that attempts to stop smoking were actually greater in the 9 months before the ban than the 7 months after. This is because people might simply be compensating by drinking and smoking more at home. Also the people outsite could become "click" like and look more attractive

Drugs are illegal